Public-private Partnership Hospitals Research Articles

Public-Private Partnership in Healthcare is a Necessity in Difficult Times: A case study

Healthcare delivery is a risky enterprise for both public and private systems which may face adversity in a volatile, uncertain, complex, and ambiguous world. There has been a global emergence of Public-Private Partnership (PPP) hospitals to enhance delivery of sustainable healthcare, although its existence in developing countries remains limited. Risk management strongly influences PPP success; few PPP hospitals were able to meet contractually specified quality and performance requirements, creating debate regarding merits of the PPP model. Conversely, we present a case study of the first PPP hospital operated by not-for-profit organisation in New South Wales, Australia, to successfully complete the contract period. A Continuous Quality and Performance Improvement Framework was applied at five stages of organisational growth during the contract term. This case study demonstrates adaptive leadership and just organisational culture are equally important in providing high quality healthcare services to the community. We show the future potential of PPP model for service delivery as a third option to pure public or private sector hospitals, even in the post COVID-19 era when there is likelihood of financial instability in many settings.

Catastrophic Health Expenditure and Out-of-pocket Payments for Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting (CABG)

Background: When households have high out-of-pocket (OOP) expenses, they are more likely to experience poverty and encounter catastrophic health expenditures (CHE). Heart disease is a significant cause of health decline and mortality. Objectives: This study aimed to provide essential knowledge about CHE and OOP for heart disease patients who underwent coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in Shiraz, Iran. Methods: This cross-sectional study with two prospective follow-ups was conducted in three heart surgery centers in Shiraz, Iran. The data were collected using the world health survey (WHS). Catastrophic health expenditures and OOP were asked from the most informed family member. Generalized estimating equation (GEE) modeling was employed to identify the main factors related to CHE and OOP. Binary distribution with logit link and gamma distribution with log link were used for CHE and OOP, respectively. The significance level was set at 0.05. Results: We found that OOP payment among patients who needed cardiovascular services in public-private partnership (PPP) hospitals was 76,953,100 Rials (R), equal to 2,506.78 $ (USD) (SD = 53,247,600 R/1,734.56 $) in the PCI group and 230,937,700 R equal to 7,522.89 $ (SD = 248,295,200 R/8,088.32 $) in the CABG group. This value in public hospitals was 15,083,800 R, equal to 491.36 $ (SD = 18,637,600 R/ 607.13 $) in the PCI group and 12,276,800 R, equal to 399.92 $ (SD = 11,131,900 R/ 362.63 $) in the CABG group. We also found that admission duration, age, type of hospital, and being currently a smoker were significant factors for OOP (P-value < 0.05). During baseline assessment, we also found that the percentage of PCI patients that faced CHE was 95.56% and 47.92% in PPP and public hospitals, respectively. This value in CABG patients was 92.31% and 40.45%. Our study showed that the type of hospital and socioeconomic status were significant factors (P-value < 0.05) that pushed a family facing CHE. Conclusions: The baseline CHE is very high in both PCI and CABG patients. Thus, the government should pay special attention to this issue. Further investigations are needed on factors affecting OOP and CHE.

Has Arthroscopic Meniscectomy Use Changed in Response to the Evidence? A Large-database Study From Spain.

Several randomized clinical trials on the treatment of meniscal tears have shown that surgery is not superior to nonoperative treatment in middle-aged and older adults. However, clinical practice has not changed consistently worldwide in response to this evidence, and arthroscopic meniscectomy remains one of the most frequently performed operations. (1) How has the use of arthroscopic meniscectomy changed in Spain between 2003 and 2018, particularly in middle-aged (35 to 59 years) and older patients (over 60 years) relative to younger patients? (2) How have surgical volumes changed across different healthcare areas in the same health system? (3) How has the proportion of outpatient versus inpatient arthroscopic procedures changed over time? Data on all 420,228 arthroscopic meniscectomies performed in Spain between 2003 and 2018 were obtained through the Atlas of Variations in Medical Practice project (these years were chosen because data in that atlas for 2002 and 2019 were incomplete). This database has been promoted by the Spanish Health Ministry since 2002, and it collects basic information on all admissions to public and public-private partnership hospitals. The Spanish population of 2003 was used to calculate age- and sex-standardized rates of interventions per 10,000 inhabitants and year. To assess the change in standardized rates among the age groups over the study period, a linear regression analysis was used. Standard small-area variation statistics were used to analyze variation among healthcare areas. Data on outpatient surgery and length of stay for inpatient procedures were also included. The standardized rate of arthroscopic meniscectomy in Spain in 2003 was 4.8 procedures per 10,000 population (95% CI 3.9 to 5.6), while in 2018, there were 6.3 procedures per 10,000 population (95% CI 5.4 to 7.3), which represents an increase of 33%. Standardized rates increased slightly in the age group < 35 years (0.06 interventions per 10,000 inhabitants per year [95% CI 0.05 to 0.08]), whereas they increased more markedly in the age groups of 35 to 59 years (0.14 interventions per 10,000 inhabitants per year [95% CI 0.11 to 0.17]) and in those 60 years and older (0.13 interventions per 10,000 inhabitants per year [95% CI 0.09 to 0.17]). The variability among healthcare areas in the meniscectomy rate progressively decreased from 2003 to 2018. In 2003, 32% (6544 of 20,384) of knee arthroscopies were performed on an outpatient basis, while in 2018, these accounted for 67% (19,573 of 29,430). We observed a progressive increase in arthroscopic meniscectomies in Spain; this procedure was more prevalent in older patients presumed to have degenerative pathologic findings. This increase occurred despite increasing high-level evidence of a lack of the additional benefit of meniscectomy over other less-invasive treatments in middle-aged and older people. Our study highlights the need for action in health systems with the use of financial, regulatory, or incentive strategies to reduce the use of low-value procedures, as well as interventions to disseminate the available evidence to clinicians and patients. Research is needed to identify the barriers that are preventing the reversal of interventions that high-quality evidence shows are ineffective. Level III, therapeutic study.

Perceived Quality and Users' Satisfaction with Public-Private Partnerships in Health Sector.

In Portugal, the government has accepted private management within public hospitals since 1996. The objectives of the state were to ensure more efficiency in resource management and maintain or increase the service quality provided to the users. Four public hospitals have been managed with a public–private partnership (PPP) approach. This study aimed to empirically analyse the degree of satisfaction of the Portuguese population regarding the service quality provided by PPP and Public Management Hospitals (PMH) within a structural equation model, and verify if people’s literacy level, age, education, and income moderate their opinions. The study used 2077 valid questionnaire responses applied in the four regions served by the eight hospitals. The results show that the users of the PPP hospitals are more satisfied than those from PMH with statistical significance. Literacy level moderates the relationship between perceived quality and users’ satisfaction, and education moderates the same relationship only in the context of PPP hospitals. More educated people with a high literacy level are more demanding, both regarding PPP and PMH hospitals. Nevertheless, the results are very beneficial to the PPP model; thus, improved decision-making regarding contract renewal might help policymakers consider the findings of this paper.

Leadership Style, Work Engagement and Organizational Commitment Among Nurses in Saudi Arabian Hospitals.

PurposeThe purpose of this paper is to examine how nurse managers’ leadership styles, work engagement, and nurses’ organizational commitment are related in Saudi Arabia.MethodsThis study used a cross-sectional design using an online survey instrument targeted at nurse managers and nurses working in Saudi Arabian hospitals. Multi-factor leadership questionnaire (MLQ), organizational commitment questionnaire (OCQ), and Utrecht Work Engagement Scale (UWES) were used in the Questionnaire. The survey link is forwarded to HR administrators of 71 hospitals, which includes public, private, and public–private partnership hospitals. The survey link was active from 27th November 2021 to 18th December 2021, and at the end of the survey, 394 responses were received. After removing the incomplete responses, 390 participant responses are considered for data analysis. t-tests and correlation analysis are used to analyze the data.ResultsAmong the participants, 84.4% of the participants were nurses and 15.6% were nurse managers. Significant difference (p < 0.05) of opinions is observed among nurse managers in relation to transformational and transactional leadership styles and engagement. Transformational and transactional leaderships are positively correlated with organizational commitment and nurses’ engagement.ConclusionDifferences in leadership style perceptions among nurses and nurse managers reflected issues in nursing management, which have to be addressed in light of rapid infrastructural changes owing to Saudi vision 2030.

Managing expectations with emotional accountability: making City Hospitals accountable during the COVID-19 pandemic in Turkey

PurposeThis paper explores the role of the COVID-19 pandemic in the financial and parliamentary accountability mechanisms of public-private partnership (PPP) “City Hospitals” in Turkey. Diverse and changing accountability mechanisms are explored regarding budgetary, affordability and emotions during the COVID-19 pandemic.Design/methodology/approachThis is a case study of City Hospitals in Turkey. Empirical data are collected and analyzed qualitatively from publicly available government and related sources, Turkish National Audit reports (Sayistay), strategic healthcare investment plans, relevant laws, decrees and NGO reports and news articles.FindingsExisting accountability mechanisms for arranging and/or delivering value-for-money (VfM) in Turkish PPP hospitals are weak. This provided policy makers with more flexibility to manage expectations of its citizens in dealing with COVID-19 pandemic. Political decision makers, through PPPs, created political capital for themselves by engaging in emotional accountability at the expense of better financial and parliamentary accountability.Originality/valueThis article contributes to the literature by articulating how roles of accountability change in crisis and introduces the concept of emotional accountability during a period of heavy infrastructure investments in City Hospitals in Turkey.

Multilevel Analysis of the Relationship between Ownership Structure and Technical Efficiency Frontier in the Spanish National Health System Hospitals.

Objective: To evaluate the relationship between the ownership structure of hospitals and the possibility of their being positioned on the frontier of technical efficiency in the economic crisis period 2010–2012, adjusting for hospital variables and regional characteristics in the areas where the Spanish National Health System (SNHS) hospitals are located. Methods: 230 National Health System hospitals were studied over the two-year period 2010–2012 according to their ownership structure—public hospitals, private hospitals and public–private partnership (PPP)—data envelopment analysis orientated to inputs was used to measure the overall technical efficiency, pure efficiency and efficiency of scale. A generalised linear mixed model (GLMM) with binomial distribution and logit link function was used to analyse the hospital and regional variables associated with positioning on the frontier. Results: There are substantial differences between the average pure technical efficiency of public, private and PPP hospitals, as well as a greater number of PPP models being positioned on the efficiency frontier (91.67% in 2012). The odds of being positioned on the frontier are 41.7 times higher in PPP models than in public hospitals. The average annual household income per region is related to the greater odds of hospitals being positioned on the frontier of efficiency. Conclusions: During the most acute period of recession in the Spanish economy, PPP formulas favoured hospital efficiency, by increasing the odds of being positioned on the frontier of efficiency when compared to private and public hospitals. The position on the frontier of efficiency of a hospital is related to the wealth of its region.

Analysis of the technical efficiency of the forms of hospital management based on public-private collaboration of the Madrid Health Service, as compared with traditional management.

The study aims to carry out a comparative analysis of the technical efficiency of hospital management based on public-private collaboration, as compared with traditional management. Specifically, we compare traditionally managed public hospitals, public hospitals managed by a private finance initiative (PFI), public hospitals managed through a public-private partnership (PPP), and hospitals managed through other forms of management, during the period 2009 to 2014, in the hospitals dependent on the Madrid Health Service (SERMAS). The study covers all publicly owned general hospitals under SERMAS, consisting of seven PFI hospitals, three PPP hospitals, 11 traditionally managed public hospitals (with the category of general hospital), and four hospitals managed through other forms of hospital management. The technical efficiency indices of the hospitals were calculated using the data envelopment analysis technique. Subsequently, a sensitivity analysis was performed by bootstrapping and variation of model variables to verify their impact on efficiency. Finally, an analysis of the evolution of efficiency in the analyzed period was carried out using the Malmquist Index. In all the analysis models carried out in the analyzed period, the hospitals managed based on public-private collaboration were more efficient than the hospitals under traditional management. The greater efficiency of hospitals managed based on public-private collaboration, as compared with traditional management, could be attributed to greater organizational and management flexibility.

"It Keeps Us from Putting Drugs in Pockets": How a Public-Private Partnership for Hospital Management May Help Curb Corruption.

Health care sector corruption diverts resources that could otherwise be used to improve access to health services. Use of private-sector practices such as a public-private partnership (PPP) model for hospital governance and management may reduce corruption. In 2011, a government-run hospital in Lesotho was replaced by a PPP hospital, offering an opportunity to compare hospital systems and practices. To assess whether a PPP model in a hospital can help curb corruption. We conducted 36 semistructured interviews with key informants between February 2013 and April 2013. We asked about hospital operations and practices at the government-run and PPP hospitals. We performed content analysis of interview data using a priori codes derived from the Corruption in the Health Sector framework and compared themes related with corruption between the hospitals. Corrupt practices that were described at the government-run hospital (theft, absenteeism, and shirking) were absent in the PPP hospital. In the PPP hospital, anticorruption mechanisms (controls on discretion, transparency, accountability, and detection and enforcement) were described in four management subsystems: human resources, facility and equipment management, drug supply, and security. The PPP hospital appeared to reduce corruption by controlling discretion and increasing accountability, transparency, and detection and enforcement. Changes imposed new norms that supported personal responsibility and minimized opportunities, incentives, and pressures to engage in corrupt practices. By implementing private-sector management practices, a PPP model for hospital governance and management may curb corruption. To assess the feasibility of a PPP, administrators should account for cost savings resulting from reduced corruption.

Public private partnerships for hospitals

Despite the growing prevalence of Public–Private Partnerships in healthcare, scholars have paid little attention to their consequences for the workforce. Public–Private Partnerships may have important consequences in labour-intensive services such as healthcare, since staff reductions and higher working loads may lead to a decrease in service quality and patient safety. In this paper, we analyse the extent to which Public–Private Partnership schemes have influenced employment in Madrid, one of the most enthusiastic adopters of Public–Private Partnership models in Spain. To do so, we compare clinical staff employment levels across three types of hospital management models, including two types of Public–Private Partnerships. Our findings illustrate that clinical staff employment levels seem to be substantially lower in Public–Private Partnership hospitals than in directly managed public hospitals, particularly as regards nursing staff, and in those types of hospitals where the private sector manages both clinical and non-clinical staff.

A cost and performance comparison of Public Private Partnership and public hospitals in Spain.

Public-private partnership (PPP) initiatives are extending around the world, especially in Europe, as an innovation to traditional public health systems, with the intention of making them more efficient.There is a varied range of PPP models with different degrees of responsibility from simple public sector contracts with the private, up to the complete privatisation of the service. As such, we may say the involvement of the private sector embraces the development, financing and provision of public infrastructures and delivery services.In this paper, one of the oldest PPP initiatives developed in Spain and transferred to other European and Latin American countries is evaluated for first time: the integrated healthcare delivery Alzira model.Through a comparison of public and PPP hospital performance, cost and quality indicators, the efficiency of the PPP experience in five hospitals is evaluated to identify the influence of private management in the results.Regarding the performance and efficiency analysis, it is seen that the PPP group obtains good results, above the average, but not always better than those directly managed. It is necessary to conduct studies with a greater number of PPP hospitals to obtain conclusive results.Electronic supplementary materialThe online version of this article (doi:10.1186/s13561-016-0095-5) contains supplementary material, which is available to authorized users.

Unhealthy policy: The political economy of Canadian public-private partnership hospitals

Public–private partnerships (P3s) with the for-profit private sector are increasingly used in Canada to deliver public infrastructure and support services within the health care sector (e.g., hospitals, clinics, community health centres). This paper examines the emergence and legacy of P3s in the Canadian health care sector, classifying them as a form of neoliberal accumulation by dispossession and discussing their inability to live up to proponents’ promises. Economic and social costs are examined, and examples are drawn from operational P3 hospitals in Canada. The article also briefly examines how P3s have been affected by the recent global financial crisis, arguing that despite serious problems with the private finance component of these projects, ultimately the policy is poised to weather the storm.